Individual provider Active NPI

Myron Ubungen, MSN RN

  • General Practice Registered Nurse
  • San Jose, CA
National Provider Identifier
1124846134
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
95060893 Issued in CA
Practice address
415 E Taylor St # 5
San Jose, CA 95112-3127
Phone
(669) 250-1515
NPI assigned
Sep 30, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 95060893 CA Primary

Addresses

Primary practice location

415 E Taylor St # 5
San Jose, CA 95112-3127

Mailing address

1559 Deluca Dr
San Jose, CA 95131-3026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
95060893CAMDGeneral Practice Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1124846134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1559 DELUCA DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951313026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E TAYLOR ST # 5",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951123127",
            "telephone_number": "669-250-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UBUNGEN",
        "first_name": "MYRON",
        "credential": "MSN RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "95060893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.